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Research of key causative genes and associated pathway in infertility based on big data of biological medicine
Jia-le WEI, Xin-yi LIU, Shao-yong LU, Xue-feng LU, Jian ZHANG
2021, 41 (10):  1277-1284. 
doi: 10.3969/j.issn.1674-8115.2021.10.001

Abstract ( 32 )   HTML ( 164 )   PDF (6155KB) ( 39 )  
Objective

·To mine regular patterns of mutation and associated causative genes through integrating big data from the perspective of genetic factors in infertility.

Methods

·A classification of causative genes collected in human infertility according to the protein category in the Universal Protein Resource (Uniprot) and statistics of mutation frequency in each kind of genes in clinical cases were made. The function and pathway of oxidoreductase with abnormal function, an important pathogenic factor, were analyzed, and related information was investigated. The mouse ortholog genes and pathogenic information of human steroid hormone biosynthesis were acquired from Mouse Genome Informatics (MGI) in order to evaluate potential genes after finding out regularity and analysis of gene interaction.

Results

·It's commonest for oxidoreductase genes to be mutated in infertility-causative genes. The genes that mutated most easily seemed possibly to focus on the steroid hormone biosynthesis pathway, and, furthermore, potential and related mutation genes were found. Aldo-keto reductase family 1 member C3 (AKR1C3), an oxidoreductase, was considered as a candidate gene bringing about human infertility most probably after analyzing this pathway.

Conclusion

·It's commonest for oxidoreductase-causative genes, which are mainly responsible for generating steroid hormone, to be mutated in infertility, and these genes maybe include AKR1C3.

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Basic research
Effects of wheeling-running exercise on AKT/mTOR pathway activity and motor-evoked potential in cortical neurons of mice
Ling-rong YI, Bo-tao TAN, Zu-xiong ZHAN, Yuan LIU, Ying YIN, Le-hua YU
2021, 41 (10):  1285-1289. 
doi: 10.3969/j.issn.1674-8115.2021.10.002

Abstract ( 25 )   HTML ( 159 )   PDF (1943KB) ( 40 )  
Objective

·To investigate the effects of various wheel-running exercise intensity on activation of protein kinase B/mammalian target of rapamycin (PKB/mTOR, AKT/mTOR) pathway in cortical neurons and nerve conduction in mice.

Methods

·Twenty four adult C57BL/6J mice were randomly divided into control group, low exercise intensity (LEI) group, moderate exercise intensity (MEI) group and high exercise intensity (HEI) group, with 6 mice in each group. The four groups of mice received pre-training for 3 days, and then received formal training (1 week) with different intensity. Motor-evoked potential (MEP) was used to detect the nerve conduction in the right upper limb of mice. The expression of AKT, ribosomal S6 protein (S6), insulin-like growth factor 1 (IGF1) and brain-derived growth factor (BDNF) in the motor cortex of mice were detected by Western blotting.

Results

·MEP test showed that compared with the control group, the N1 latency period of MEP in the LEI group, MEI Group and HEI group was shorter (all P<0.05); compared with the HEI group, the N1 latency period in the LEI group was shorter (P=0.032). Meanwhile, compared with the control group, the P1 latency period of MEP in the LEI group was also shorter (P=0.015). Western blotting results showed that compared with the control group, the expression levels of p-AKT/AKT and p-S6/S6 in the motor cortex of mice in the LEI group, MEI Group and HEI group were significantly increased (all P<0.05); the expression levels of IGF1 and BDNF in the motor cortex of mice in the LEI group were higher than those in the control group (both P<0.05).

Conclusion

·Low intensity exercise training can activate AKT/mTOR pathway of cortical neurons and improve the nerve conduction speed, which may be related to the increased nerve growth factors.

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Relation of down-regulation of METTL10 and podocyte injury
Ji-wen BAO, Zi-yang LI, Huan-zhen YAO, Bei WU, Wen-yan ZHOU, Le-yi GU, Ling WANG
2021, 41 (10):  1290-1296. 
doi: 10.3969/j.issn.1674-8115.2021.10.003

Abstract ( 23 )   HTML ( 160 )   PDF (3508KB) ( 38 )  
Objective

·To identify the differentially expressed genes (DEGs) in podocyte injury and validate the expression of METTL10, one of these critical genes.

Methods

·The microarray expression profile of a podocyte injury model, dataset GSE108629, was downloaded from the GEO database, containing 4 normal podocyte samples and 4 injured podocyte samples, and the DEGs were diagnosed using the limma software package and affy software package (|log FC| ≥ 2 and adjusted P value<0.05). Patients with significant proteinuria who underwent renal biopsy and were diagnosed as focal segmental glomerulosclerosis or minimal change disease were retrospectively enrolled. Control group was patients who underwent renal biopsy and were proven as slight pathological changes or benign arteriolar neophrosclerosis. The general and clinical data were collected, and the expression of METTL10 in renal tissue was detected by immunofluorescence staining. Adriamycin (ADR)-induced nephropathy mouse model was established by a single intravenous injection of ADR into BAL/BC mouse. Mice were randomly divided into two groups: control group (treated with the same volume of PBS) and ADR group (treated with ADR 10 mg/kg body weight). On Day 0 and Day 14, urine was collected for 24 h using a metabolic cage and urinary albumin creatinine ratio (UACR) of mice were detected; on Day 15, mice were sacrificed and kidney tissue was collected. The expression of METTL10 and podocyte marker proteins like synaptopodin, nephrin, podocin, and Wilms' tumor 1 (WT1) in kidneys from ADR-treated mouse model was analyzed by Western blotting.

Results

·A total of 5 353 genes were significantly differentially expressed in injured podocytes compared with intact podocytes, among which 3 402 DEGs were up-regulated and 1 951 DEGs were down-regulated. METTL10 was found to be one of those that overe significantly down-regulated. Immunofluorescence staining indicated that METTL10 was expressed in normal human glomeruli and METTL10 was colocalized with podocalyxin, one of podocyte specific markers. Additionally, METTL10 was low expressed in the renal biopsy specimens from patients with significant proteinuria compared with that in the control group. On Day 14 after administration of ADR, mice developed significant proteinuria, shown by UACR detection (P=0.005); Western blotting revealed that METTL10 was significantly down-regulated (P=0.001), along with the significantly decreased expression of synaptopodin (P=0.001), nephrin (P=0.005), podocin (P=0.000) and WT1 (P=0.006) in ADR-treated mice compared with that in normal mice. The differences of the expression of METTL10 and the above podocyte markers between these two groups were statistically significant.

Conclusion

·The down-regulation of METTL10 may be involved in podocyte injury.

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Preparation and crystallization of a novel oral bacterial serine protease inhibitor Tannerpin
Ting-ting YANG, Jia-wei XU, Ai-wu ZHOU, Wei YE
2021, 41 (10):  1297-1302. 
doi: 10.3969/j.issn.1674-8115.2021.10.004

Abstract ( 16 )   HTML ( 3 )   PDF (2127KB) ( 13 )  
Objective

·To prepare and crystallize a novel oral bacterial serine protease inhibitor Tannerpin with high purity by means of biochemistry and structural biology.

Methods

·A novel serine protease inhibitor was screened from periodontal disease-related bacteria by amino acid sequence analysis, and named as Tannerpin. The fusion expression vector pSUMO3-Tannerpin was constructed and transferred into E. coli BL21 (DE3) system for induction expression. Tannerpin was isolated and purified by a combination of nickel-affinity chromatography, SUMO-specific protease 2 (SENP2) digestion and gel filtration chromatography, and was verified by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Then, the crystallization conditions of the purified protein were screened and optimized, and its acting substrates were screened.

Results

·SDS-PAGE showed that SUMO3-Tannerpin fusion protein was successfully expressed in E. coli. After removing the fusion label of the protein by purification scheme, Tannerpin with relative molecular weight of about 43 000 was obtained. After crystallization screening and optimization, Tannerpin crystals with a resolution of 1.7 ? were finally obtained under the conditions of 20 ℃, pH=6.0, precipitant of 28% polyethylene glycol 3350 and 8% Tacsimate. However, the acting substrate of Tannerpin was not obtained.

Conclusion

·A novel serine protease inhibitor Tannerpin secreted by oral bacteria and its crystal are successfully prepared, which may lay a foundation for subsequent structural analysis and functional study.

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Clinical research
Association study of CREB1 gene with depression and bipolar disorder typeⅡ
Bo SHI, Jian-min CHEN, Jun-xiong ZHAO, Wei TANG, Wei-xing FAN, Cheng-cheng ZHANG, Chen ZHANG
2021, 41 (10):  1303-1307. 
doi: 10.3969/j.issn.1674-8115.2021.10.005

Abstract ( 16 )   HTML ( 2 )   PDF (1195KB) ( 16 )  
Objective

·To study the association of CREB1 gene with depression and bipolar disorder type Ⅱ.

Methods

·Three hundred and sixty-two patients with depression, 381 patients with bipolar disorder type Ⅱ and 416 healthy subjects were included. There were no significant differences in gender, age and year of education between depression group, bipolar disorder type Ⅱ group and control group. Patients with severity of depression were evaluated by Hamilton Depression Rating Scale. Hypomania Check List-32 was used to screen the history of hypomanic episode of patients with depression and patients with bipolar disorder type Ⅱ. A total of 2 mL of venous blood was collected from each subject, and whole genome of peripheral blood leukocyte DNA was extracted using a centrifugal column genomic DNA kit. Single nucleotide polymorphism (SNP) genotyping of SNaPshot was used to identify the rs10932201 and rs3770704 loci of CREB1 gene, and the effects of SNP on CREB1 expression in brain were analyzed using BRAINEAC database.

Results

·The genotypes of rs10932201 and rs3770704 of CREB1 gene in the depression group, bipolar disorder type Ⅱ group and control group were well matched with Hardy-Weinberg equilibrium (P>0.05). Linkage disequilibrium analysis showed that there was a strong linkage disequilibrium between rs10932201 and rs3770704 (r2>0.4). At the rs10932201 locus of CREB1 gene, there was a significant difference in allelic frequency between the bipolar disorder type Ⅱ group and the control group (χ2=4.27, P=0.042); there was no difference in allelic frequency between the depression group and the control group. There were no significant differences in either allelic or genotypic frequency of rs3770704 of CREB1 gene in the depression group and bipolar disorder type Ⅱ group compared with the control group. In the haplotype constructed between rs10932201 and rs3770704 of CREB1 gene, the frequency of haplotype A-T in the bipolar disorder type Ⅱ group was 57.5%, which was statistically significant (χ2=4.07,P=0.044). Expression quantitative trait loci analysis showed that rs10932201 was associated with CREB1 gene expression in temporal cortex (P=0.048).

Conclusion

·The rs10932201 of CREB1 gene is associated with bipolar disorder type Ⅱ, and may be a risk factor for bipolar disorder type Ⅱ, not depression.

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Analysis of the efficacy of endovascular thermal ablation (980 nm laser) combined with foam sclerotherapy in day surgery for lower extremity varicose vein
Yong-chuan LI, Xin-wu LU, Zhi-hua ZHANG, Jin-bao QIN, Xing ZHANG
2021, 41 (10):  1308-1312. 
doi: 10.3969/j.issn.1674-8115.2021.10.006

Abstract ( 7 )   HTML ( 2 )   PDF (915KB) ( 8 )  
Objective

·To compare and analyze the therapeutic effect of 980 nm laser endovascular thermal ablation (EVTA) combined with foam sclerotherapy on day surgery (local anesthesia) and high ligation of great saphenous vein+810 nm laser EVTA combined with foam sclerotherapy on inpatient surgery (general anesthesia) for patients with lower extremity varicose vein.

Methods

·Data of the patients who underwent the above different surgical procedures respectively in the Department of General Surgery, The First Hospital of Xuzhou Mining Group from March 2019 to March 2020 were retrospectively analyzed, including 111 day surgery patients (980 nm group) and 107 inpatient surgery patients (810 nm group). The baseline data, postoperative data and follow-up data were collected, and the differences between the two groups were compared.

Results

·There was no significant difference between the two groups in baseline data and follow-up data. After operation, the 980 nm group was better than the 810 nm group in pain score, duration of pain, the proportion of using painkillers, the time required to resume daily life and economic cost (all P<0.05).

Conclusion

·Endovascular thermal ablation (980 nm laser) combined with foam sclerotherapy in the day surgery for lower extremity varicose vein has certain advantages in postoperative comfort, hospitalization time and cost, which will provide a new option for patients who are not suitable for general anesthesia.

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Half effective bolus dose of dexmedetomidine of children derived from the up-and-down experimental data based on the analysis of nonlinear mixed effects model with allometric equation
Wen-yin XU, Zhen-ling HUANG, Yong-lei HUANG, Rui-dong ZHANG, Lu WANG, Ying ZHANG, Jie BAI, Ji-jian ZHENG
2021, 41 (10):  1313-1317. 
doi: 10.3969/j.issn.1674-8115.2021.10.007

Abstract ( 11 )   HTML ( 1 )   PDF (1195KB) ( 8 )  
Objective

·To explore the application of nonlinear mixed effects model based on the allometric equation on up-and-down data to determine the half effective dose (ED50) in pediatric patients.

Methods

·Twenty-two pediatric patients aged 2 to 12 years with obstructive sleep apnea (OSA) who were undergoing drug-induced sleep endoscopy (DISE) were enrolled. All patients received intravenous bolus S+-ketamine 0.5 mg/kg. At the same time, a predetermined bolus dose of dexmedetomidine was infused continuously over 10 min for anesthesia induction. The bolus dose of dexmedetomidine was calculated according to the Dixon up-and-down method with initial dose 1.0 μg/kg and step size 1.2 times. DISE was conducted 10 min after dexmedetomidine infusion, and the response of the patients to the procedure was recorded. Dixon-Massey formula and nonlinear mixed effects model fitting are used to calculate ED50.

Results

·There were 9 and 13 children with successful and failed sedation. The value of dexmedetomidine ED50, 1.9 μg/kg, calculated by Dixon-Massey formula was similar to the fitting value, 2.0 μg/kg, of nonlinear mixed effects model. The introduction of allometric equation significantly improved the model (P<0.05). After normalizing adults' body weight to 70 kg, the ED50 and ED95 were 5.76×(body weight/70) μg/kg and 11.5×(body weight/70) μg/kg, and the slope (γ) of the dose-response relationship of dexmedetomidine is 4.25.

Conclusion

·The experimental data from the up-and-down method can be fitted with a nonlinear mixed effects model based on the allometric equation. Compared with the Massey formula, the advantage is that the ED50, ED95 and γ can be determined at the same time, and this method helps to determine the possible effect of covariates.

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Diagnostic value of Xpert MTB/RIF in lymph node tuberculosis
Hui KE, Xu-wei GUI, Jin GU
2021, 41 (10):  1318-1322. 
doi: 10.3969/j.issn.1674-8115.2021.10.008

Abstract ( 11 )   HTML ( 1 )   PDF (838KB) ( 8 )  
Objective

·To analyze the significance of the combination of rifampicin-resistant Mycobacterium tuberculosis semi-nested multiple real-time fluorescence quantitative system (Xpert MTB/RIF) detection in improving the diagnostic rate of lymph node tuberculosis.

Methods

·Retrospective analysis was performed on the clinical data of 351 patients who were initially diagnosed with cervical lymph node tuberculosis and received lymph node puncture in Shanghai Pulmonary Hospital from January 2016 to December 2018. The lymph node puncture materials were sent for tuberculosis smear, tuberculosis culture,tuberculosis DNA test, pathology test and Xpert MTB/RIF test. The positive rates of different detection methods and tuberculosis smear, tuberculosis culture, tuberculosis DNA test and pathological test combined with Xpert MTB/RIF test were analyzed.

Results

·A total of 145 patients with confirmed lymph node tuberculosis were included. Among them, 39 patients were tuberculosis smear positive, 74 patients were tuberculosis DNA positive, 111 patients were Xpert MTB/RIF positive, 51 patients were tuberculosis culture positive, and 87 patients were pathologically positive. Xpert MTB/RIF detected 8 patients with rifampicin drug resistance, of which 6 patients were negative in tuberculosis culture, and 2 patients were rifampicin drug resistant in tuberculosis culture. The positive rate of tuberculosis DNA combined with Xpert MTB/RIF was the highest (91.0%), which was significantly higher than that of tuberculosis smear combined with Xpert MTB/RIF (80.7%), and the difference was statistically significant (P=0.017). It was also higher than that of tuberculosis culture combined with Xpert MTB/RIF test (88.3%) and pathology combined with Xpert MTB/RIF test (90.3%), but there was no statistical significance (all P>0.05).

Conclusion

·The combination of Xpert MTB/RIF could improve the early diagnosis rate of lymph node tuberculosis.

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Construction of a decision-making model for primary headache based on Nomogram
Fang-fang LIU, Guan-shui BAO, Meng-xia YAN
2021, 41 (10):  1323-1329. 
doi: 10.3969/j.issn.1674-8115.2021.10.009

Abstract ( 6 )   HTML ( 3 )   PDF (1408KB) ( 10 )  
Objective

·To establish a decision-making model for primary headache based on Nomogram.

Methods

·Two hundred and ten patients with migraine or tension-type headache who visited the Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine between October 2019 to December 2020 were studied retrospectively. Among them, 152 patients who visited the hospital from October 2019 to August 2020 were served as the modeling group. Fifty eight patients who visited the hospital from September 2020 to December 2020 were served as the validation group. Univariate and multivariate Logistic regression were used to analyze the independent predictive factors to distinguish migraine and tension-type headache. According to the regression coefficient of independent variables, R software was used to construct a nomogram model of migraine or tension-type headache. The internal verification of the model was carried out through Bootstrap, and the external verification was carried out according to the data of the validation group. Receiver operator characteristic curve (ROC curve), area under the curve (AUC) and calibration curve were used respectively to estimate the discrimination and calibration of the prediction model.

Results

·There were 80 patients with migraines and 72 patients with tension-type headaches in the modeling group. There were 35 patients with migraines and 23 patients with tension-type headaches in the validation group. There was no statistical difference in characteristics between the modeling group and the validation group. According to the results of univariate Logistic analysis, 9 characteristic variables were extracted and included in the multivariate analysis. Multivariate Logistic regression analysis showed the independent predictive factors that were used to distinguish migraine and tension-type headache, including course, whether the headache was located in the occipital, severity intensity of the headache, whether the headache was accompanied by nausea/vomiting, whether the headache was accompanied by photophobia/phonophobia and the change of headache after activities. The decision Nomogram model was constructed based on this result. The internal and external verification of the model found that AUC of the modeling group and the validation group were 0.896 [95% confidence interval (CI) 0.842?0.950] and 0.884 (95%CI 0.793?0.976) respectively, suggesting that the prediction model has a good discrimination capacity.The calibration curve of the modeling group and the validation group was very close to the standard curve, and had a good calibration degree, which showed that the model was consistent in the two groups.

Conclusion

·This study has constructed a decision-making model for distinguishing migraine and tension-type headache based on Nomogram. The model has a good discrimination and calibration in the modeling group and the validation group, which is beneficial to improve clinicians' early identification and diagnosis capabilities for migraine and tension-type headache.

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Surgical and oncological outcome of 79 consecutive patients with unilateral favorable histology Wilms tumor treated in one single institution following an upfront tumor surgical strategy
Chen-jie XIE, Yi-jin GAO, Min-zhi YIN, Jiao-yang CAI, An-an ZHANG, Yue-jia TANG, Song GU, Ci PAN, Jing-yan TANG, Min XU
2021, 41 (10):  1330-1335. 
doi: 10.3969/j.issn.1674-8115.2021.10.010

Abstract ( 9 )   HTML ( 2 )   PDF (966KB) ( 8 )  
Objective

·To improve the understanding of upfront surgical strategy in the treatment of Wilms tumor (WT) and standardize the upfront resection procedure and subsequent chemotherapy and/or radiotherapy approach, providing necessary data support for clinical study in childhood WT in China.

Method

·From January 1, 2010 to December 30, 2017, the clinical records of patients with unilateral favorable histology WT (FHWT) who were initially diagnosed at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine were retrospectively collected. All cases were diagnosed, staged and treated according to the Chinese Children Cancer Group (CCCG)-WT-2009 or CCCG-WT-2015 Protocol. Surgical outcome, event-free survival (EFS) and overall survival (OS) were analyzed using SPSS software, version 25.0. Follow-up was updated to March 31, 2020.

Result

·A total of 79 consecutive cases with unilateral FHWT were enrolled, including 41 males and 38 females, with a median age of 27.1 months. Systemic staging showed that there were 7 cases with stage Ⅰ, 39 cases with stage Ⅱ, 23 cases with stage Ⅲ and 10 cases with stage Ⅳ. Sixty-nine patients (87.3%) underwent nephrectomy and 10 patients (12.7%) underwent biopsy of renal tumor tissue (2 with core needle biopsy and 8 with open biopsy) in the primary operation. Eleven cases experienced disease progression/recurrence and 1 abandoned treatment and returned to original treatment plan after 8 weeks. Local radiation therapy was applied to 27 of 32 patients with indication. Only 3 of 10 patients with lung metastasis at diagnosis received whole lung radiation therapy. A median follow-up of 69 cases without incident was 69.8 months. The 5-year EFS and OS of all cases were 84.8% and 92.4% respectively. The 5-year EFS of children with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 100.0%, 84.6%, 95.7% and 50.0% (P=0.010), respectively. And the 5-year OS of children with stage Ⅰ, Ⅱ, Ⅲ and Ⅳ were 100.0%, 94.9%, 95.7 and 70.0% (P=0.070), respectively. The 5-year EFS of children with stage Ⅲ/Ⅳ receiving initial nephrectomy was higher than that of those undergoing biopsy (91.3% vs 60.0%, P= 0.032). The 5-year EFS of children with initial biopsy, who underwent nephrectomy at week 6 was significantly higher than that of those who did not (100% vs 0, P=0.005).

Conclusion

·The upfront tumor surgical strategy of unilateral WT is safe, feasible and effective in the treatment of FHWT. Initial nephrectomy and clearance of all local diseases with lymph nodal sampling is the key to staging and successful treatment.

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Prognostic value of delayed diuretic 18F-FDG PET/CT before radical cystectomy for bladder cancer
Kun ZHOU, Yu-mei CHEN, Jian-jun LIU, Gang HUANG
2021, 41 (10):  1336-1343. 
doi: 10.3969/j.issn.1674-8115.2021.10.011

Abstract ( 10 )   HTML ( 1 )   PDF (1661KB) ( 11 )  
Objective

·To evaluate the prognostic value of preoperative delayed diuretic 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) imaging in patients with bladder cancer.

Methods

·The clinical data and preoperative delayed diuretic 18F-FDG PET/CT images of 104 bladder cancer patients who received radical cystectomy (RC) from 2016 to 2018 at Renji Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively analyzed. The diagnostic ability and optimal boundary values of maximum standardized uptake value (SUVmax), tumor metabolic volume (MTV) and total lesion glycolysis (TLG) were obtained by receiver operating characteristic curve (ROC) analysis. Patients were divided into high SUVmax group (n=53) and low SUVmax group (n=51), high MTV group (n=52)and low MTV group (n=52), high TLG group (n=67)and low TLG group (n=37). The correlation between PET/CT metabolic parameters and clinical data was analyzed by chi-square test. Survival curves were drawn by Kaplan-Meier method and tested by Log-rank method. The prognostic value of metabolic parameters was evaluated by Cox regression model.

Results

·MTV (P=0.000) and TLG (P=0.000) had diagnostic abilities for postoperative recurrence of bladder cancer. Preoperative treatment (P=0.033) and T stage of tumor (P=0.035) were correlated with MTV, while neutrophil-lymphocyte ratio (NLR) (P=0.026), hemoglobin (P=0.004), albumin(P=0.021), preoperative treatment (P=0.015) and T stage (P=0.015) were related to TLG. Multivariate Cox regression analysis showed that lymph node metastasis (HR=2.433, P=0.016) and TLG (HR=4.499, P=0.000) were independent prognostic factors of progression-free survival (PFS), while preoperative treatment (HR=0.220, P=0.014) and TLG (HR=7.107,P=0.013) were independent predictors of overall survival (OS).

Conclusion

·Delayed diuretic 18F-FDG PET/CT before RC can predict the postoperative survival.

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Evidence-based medicine
Application of two kinds of analgesia after colorectal cancer surgery: a meta-analysis
Zhi-ling CHEN, Chen LUO, Kang-jia ZHAO, Ling SHEN, San-lian HU
2021, 41 (10):  1344-1350. 
doi: 10.3969/j.issn.1674-8115.2021.10.012

Abstract ( 21 )   HTML ( 1 )   PDF (2378KB) ( 25 )  
Objective

·To explore the safety and the analgesia effect of intravenous analgesia and epidural analgesia in the patients with colorectal cancer after surgery.

Methods

·The literature search was conducted in the Chinese databases, i.e. CNKI, WanFang, CBM, and VIP, and the abroad databases, i.e. PubMed, Web of Science, Embase, Cochrane Library and Joanna Briggs Institute (JBI) for randomized controlled trials (RCTs), controlled clinical trials (CCTs) and case-control studies (CCSs) about the effects of intravenous analgesia and epidural analgesia on the patients with colorectal cancer after surgery from January 2010 to November 2020, in the languages of Chinese and English. Three researchers independently conducted literature screening and quality evaluation in strict accordance with the standards, and extracted effective data such as study type, sample size, age, intraoperative anesthesia mode, postoperative analgesic drugs and outcome indicators, which were input into RevMan 5.4 software for meta-analysis.

Results

·A total of 20 literatures, including 13 RCTs, 6 CCTs and 1 CCS, involving 1 615 patients. There were 813 cases in the epidural analgesia group and 802 cases in the intravenous analgesia group. Compared with intravenous analgesia, postoperative epidural analgesia had significant lower visual analogue scores (VAS) of pain at 6 h, 24 h, and 48 h, shorter hospital stay and time to first feeding after operation, and lower incidences of ileus and nausea and vomiting (all P<0.05).

Conclusion

·Compared with intravenous analgesia, postoperative epidural analgesia for the colorectal neoplasms patients is better in the analgesic effect 6 h, 24 h, and 48 h after surgery, effectively shortens the hospital stay and time to first feeding after operation, and reduces the incidences of ileus and nausea and vomiting.

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Public health
Reliability and validity evaluation of Chinese version of Brief HIV Knowledge Questionnaire for HIV-negative sexually transmitted diseases patients
Da-ke SHI, Su-ping WANG, Rui-jie GONG, Yang NI, Yong CAI
2021, 41 (10):  1351-1358. 
doi: 10.3969/j.issn.1674-8115.2021.10.013

Abstract ( 10 )   HTML ( 1 )   PDF (1335KB) ( 10 )  
Objective

·To introduce the Brief human immunodeficiency virus (HIV) Knowledge Questionnaire (HIV-KQ-18), evaluate the reliability and validity of the scale in the HIV-negative sexually transmitted diseases (STD) patients, and predict the population's sexual behavior based on its knowledge score.

Methods

·A total of 599 eligible patients who attended the outpatient clinic of Shanghai Skin Disease Hospital from January 2018 to December 2018 were evaluated by the Chinese version of HIV-KQ-18, and they were randomly allocated into two groups for exploratory factor analysis (n=300) and confirmatory factor analysis (n=299). Consistent condom use when having sex was judged as safe sexual behavior and used as a dependent variable, and HIV-KQ-18 scores were used as independent variables for receiver operating characteristic curve analysis to predict safe sexual behavior.

Results

·The exploratory factor analysis showed that three factors including the transmission of HIV (7 items), preventive measures (4 items) and consequences of being infected with HIV (3 items) could be extracted. Four items were removed from HIV-KQ-18 to form the Chinese version of HIV-KQ-14. Confirmatory factor analysis showed that the model revised by three factors fitted well (χ2/df=2.046, root mean square error of approximation=0.059, incremental fit index=0.926, Tucker-Lewis index=0.908, comparative fit index=0.925). The Cronbach′s α of the scale was 0.861, and the Spearman-Brown coefficient was 0.815; the area under the curve of safe sexual behavior was 0.708 (P=0.000).

Conclusion

·The Chinese version of the HIV-KQ-14 has good reliability and validity in HIV-negative STD patients, and has a good predictive ability for safe sexual behavior.

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Reliability and Validity of Corona Virus Disease 2019 (COVID-19) Peritraumatic Distress Index (CPDI)
Jing TAO, Qing-zhi ZENG, Jin DANG, Jian-yin QIU
2021, 41 (10):  1359-1365. 
doi: 10.3969/j.issn.1674-8115.2021.10.014

Abstract ( 11 )   HTML ( 2 )   PDF (1076KB) ( 18 )  
Objective

·To explore the reliability and validity of Corona Virus Disease 2019 (COVID-19) Peritraumatic Distress Index (CPDI) in evaluating pandemic-related acute stress reaction.

Methods

·From 31 January 2020 to 29 February 2020, CPDI, Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7) and Self-reporting Questionnaire-20 (SRQ-20) were measured in 253 outpatients, their family members and medical staff of our hospital. At the same time, leveraging the Siuvo Intelligent Psychological Assessment Platform, we presented QR codes of the CPDI questionnaire online openly, accessible to the participants nationwide, and received a total of 75 867 valid responses. Cronbach's α coefficient was used to evaluate the internal consistency. The correlation between CPDI and PHQ-9, GAD-7 and SRQ-20 was used to test the criterion validity. Exploratory factor analysis was used to detect the structural validity and the cut-off score of the questionnaire to screen the psychological symptoms associated with COVID-19 was also detected.

Results

·The Cronbach's α of the 15-item questionnaire was 0.932. The correlation coefficients between the 15-item CPDI and PHQ-9, GAD-7 and SRQ-20 were 0. 670, 0.699 and 0.711 respectively (all P=0.000). The exploratory factor analysis results contained 15 items and 4 factors, the factor load was 0.491-0.681, and the cumulative variance interpretation rate was 72.006%. In terms of cut-off score, it was identified as suspicious symptom by cut-off score of 10/11 points. The sensitivity and specificity were 0.822 and 0.811, respectively. The cut-off score to confirm the presence of symptoms was 14/15 points. The sensitivity and specificity were 0.815 and 0.824, respectively.

Conclusion

·The study indicates that CPDI is with good internal consistency reliability, criterion validity and structural validity.

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Review
Progress of transcranial direct current stimulation in the treatment of children and adolescents psychiatric disorders
Nuo-shi QIAN, Wu HONG, Chun-bo LI
2021, 41 (10):  1366-1370. 
doi: 10.3969/j.issn.1674-8115.2021.10.015

Abstract ( 20 )   HTML ( 4 )   PDF (805KB) ( 19 )  

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique. It can modulate brain current activities and treat psychiatric disorder through affecting neural excitability and synaptic plasticity. At present, there are substantial application researches of tDCS, and it is effective on the treatment of adult depressive disorder, bipolar depressive disorder, schizophrenia and other mental diseases. Preliminary researches have showed that children and adolescents have certain tolerance to tDCS, however, there are only few randomized controlled clinical studies about tDCS applying to the children and adolescents with psychiatric disorders, and reliable conclusions couldn't be drawn due to limitations of small sample size and open label trials. This paper reviews the utilization of tDCS among children and adolescents with schizophrenia, attention deficit/hyperactivity disorder, autism spectrum disorder and dyslexia. Details including parameters, efficacy, side effects and limitations are discussed, and different sessions, duration, current, intensity, stimulation sites and effect are compared. Information discussed may provide reference for development of neuromodulation techniques and clinical applications of tDCS to the treatment of children and adolescents with psychiatric disorders.

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Research progress in immune pathogenesis of unexplained recurrent spontaneous abortion
Wen-xin BAI, Ai-min ZHAO
2021, 41 (10):  1371-1377. 
doi: 10.3969/j.issn.1674-8115.2021.10.016

Abstract ( 16 )   HTML ( 1 )   PDF (875KB) ( 15 )  

Recurrent spontaneous abortion (RSA) is one of the most common pregnancy complications in gynecology and obstetrics. The etiology of RSA is complex and diverse. In addition to the known causes such as autoimmune abnormalities, thrombophilia, endocrine factors, anatomical abnormalities of female genital tract, chromosome abnormalities of husband and wife, and fetal chromosome or gene abnormalities, there are still 40%?50% of patients cannot find the exact cause, which is called unexplained recurrent spontaneous abortion (URSA). Due to the unknown etiology, it also brings great trouble to develop effective therapy. In recent years, with the development of reproductive immunology, more and more evidences suggest that the occurrence of URSA is related to the imbalance of maternal-fetal immune mechanisms, which also brings hope for the development of therapeutic strategies for URSA. This article reviews the concept of maternal-fetal interface and maternal-fetal immune tolerance, the mechanism of formation and imbalance of maternal-fetal immune tolerance, and the research progress of immune pathogenesis of URSA.

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Research advances in mechanisms of super-enhancers-driven oncogenesis
Peng GU, Xing SUN
2021, 41 (10):  1378-1383. 
doi: 10.3969/j.issn.1674-8115.2021.10.017

Abstract ( 14 )   HTML ( 6 )   PDF (928KB) ( 15 )  

Transcriptional dysregulation is one of the core mechanisms of tumorigenesis. Recently, the term "super-enhancer" has been introduced to describe a hyperactive regulatory domain which comprises a complex array of sequence elements that are critical to maintain the identity of tumor cells and promot oncogenic transcription. Super-enhancers are highly occupied by transcriptional factors, co-activators and histone modifications. Cooperative interactions amongst these components make super-enhancers have higher transcriptional activity than typical enhancers. This article reviews basic structural and functional characteristics of super-enhancers, formation of the phase-separated condensates, the mechanisms of super-enhancer-driven oncogenesis, and the formation and significance of topologically associating domains.

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Research progress in the mechanism of helper T cell 17 and regulatory T cell in depression
Rui-xue YUAN, Ying-mei FU, Shun-ying YU
2021, 41 (10):  1384-1388. 
doi: 10.3969/j.issn.1674-8115.2021.10.018

Abstract ( 12 )   HTML ( 2 )   PDF (806KB) ( 14 )  

Depression is a global mental illness with increasing incidence, heavy disease burden and complicated pathogenesis. In recent years, based on the inflammatory hypothesis of depression, studies have demonstrated that the occurrence and development of the disease is closely related to the immune imbalance mediated by helper T cell 17 (Th17) and regulatory T cell (Treg). Moreover, reports have shown that both Th17 and Treg can be regulated by gut microbiome which involves in the pathogenesis of depression through the brain-gut axis mechanism. In addition, basic and clinical researches reveal that the levels of Th17 and Treg in peripheral blood are capable of affecting the efficacy of antidepressants. Therefore, this article combines the studies of gut microbiome to briefly review the research progress in the effect of Th17 and Treg on the pathogenesis of depression and the treatment of antidepressants.

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Progress in surgical strategies of pulmonary atresia with ventricular septal defect
Zhi-ying SONG, Jing-hao ZHENG
2021, 41 (10):  1389-1393. 
doi: 10.3969/j.issn.1674-8115.2021.10.019

Abstract ( 12 )   HTML ( 4 )   PDF (778KB) ( 10 )  

Pulmonary atresia with ventricular septal defect is one of the most common complex right heart malformations. The existence of major aortopulmonary collateral arteries and the individual differences in pulmonary vascular development make the anatomical classification and surgical methods of this disease variable, and the treatment effect is not ideal. At present, there is still a lack of unified standards and procedures for treatment strategies such as unifocalization and staged surgery at home and abroad. This article reviews the progress of surgical diagnosis and treatment and surgical strategy of pulmonary atresia with ventricular septal defect.

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Research progress of effect of estrogen and its receptors on cholesterol gallstone disease
Qian ZHUANG, Zhi-xia DONG, Xin-jian WAN
2021, 41 (10):  1394-1396. 
doi: 10.3969/j.issn.1674-8115.2021.10.020

Abstract ( 15 )   HTML ( 2 )   PDF (804KB) ( 9 )  

Gallstone disease is a common disorder of the digestive system. Cholesterol supersaturation in bile and gallbladder contraction dysfunction are important pathophysiological mechanisms of cholesterol gallstone formation. Estrogen and its receptors can affect cholesterol gallstone formation through regulating cholesterol and bile acid metabolism and gallbladder contraction. Classical nuclear receptors such as estrogen receptor α and estrogen receptorβ, as well as novel membrane receptors such as G protein-coupled receptor 30, play an important role in cholesterol gallstone formation. The design and synthesis of selective antagonists targeting estrogen receptors may be a potential strategy for the prevention and treatment of cholesterol gallstone disease. In this paper, the research progress of effect of estrogen and its receptors on cholesterol gallstone disease in recent years is reviewed.

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Advances in resilience research
Shuang-yi CHEN, Jian-yin QIU
2021, 41 (10):  1397-1400. 
doi: 10.3969/j.issn.1674-8115.2021.10.021

Abstract ( 11 )   HTML ( 0 )   PDF (773KB) ( 11 )  

Resilience refers to the dynamic process of individual's positive adaptation to adversity, which is closely related to the symptoms of mental disorders and can be improved through intervention. This paper reviews the definition, evaluation method and intervention of resilience, and proposes that resilience can be used as an indicator of mental disorders related to stressor exposure, which has certain reference significance for improving individual resilience and promoting individual mental health development.

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Case report
Malignant tumor complicated with bone marrow necrosis in children: a report of 2 cases with literature review
Li-hui WANG, Zhen WANG, Huan WANG, Hong LI, Hui JIANG, Jing-bo SHAO
2021, 41 (10):  1401-1404. 
doi: 10.3969/j.issn.1674-8115.2021.10.022

Abstract ( 13 )   HTML ( 0 )   PDF (1264KB) ( 12 )  

Case 1 is a 6-year-old boy, who was admitted to hospital in April, 2020 due to ??the left scrotal painless tumor found more than 1 year ago, with enlargement for16 d ''. The testicular tumor was removed by orchiectomy, and pathological examination suggested myeloid sarcoma, but the family members refused chemotherapy. Three months after the orchiectomy, the patient had fever and anemia. The bone marrow smears showed bone marrow necrosis. After 1 week of anti-infection treatment, bone marrow smears showed tumor cells while bone marrow biopsies suggested bone marrow metastasis of myeloid sarcoma. The patient had bone marrow remission after chemotherapy. Case 2 is a 11-year-old girl. She was admitted for ??weakness, poor appetite for 1 month, fever for 3 d'' in December 2012. Abdominal CT showed retroperitoneal malignant tumor with multiple bone metastasis. Bone marrow smear showed bone marrow necrosis. The diagnosis was neuroblastoma, and the patient was in remission after treatment. In May 2020, she was admitted for ??bone pain with fever for 3 d''. Bone marrow smear showed tumor recurrence. Anti-infection and chemotherapy were given, and bone marrow reexamination showed bone marrow necrosis. After aggressive anti-infection treatment, the bone marrow showed remission. She had hematopoietic stem cell transplantation, and now is on a post-transplant follow-up.The cause of bone marrow necrosis is complicated and malignant tumor is a common cause. For tumor cells, bone marrow biopsy can diagnose the disease more effectively than bone marrow smears. Prompt diagnosis and active treatment of the primary disease, which can cause bone marrow necrosis, can improve the prognosis.

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